Renal Tumors In Children Research Articles

Robot-assisted resection of renal tumor in children and comparison with laparoscopic surgery

BackgroundRobot-assisted surgery (RAS) is being performed with increasing frequency in pediatric oncology. We report our experience with RAS for renal tumors in children and compare the outcomes between RAS and laparoscopic surgery (LAS).MethodsA total of 23 patients with renal tumor who underwent minimally invasive surgery (MIS) between January 2020 and December 2023 were included in the study. The inclusion criteria enrolled in this study was unilateral tumors with maximum tumor diameter less than 10 cm. Patients who had enlarged lymph node, venous thrombosis, preoperative tumor rupture, bilateral renal tumor, or extrarenal extension on imaging were deemed contraindications and excluded. Patient demographics, operative details, postoperative outcomes and follow-up were recorded.ResultsAmong these patients, 17 underwent RAS and 6 underwent LAS. In the RAS group, the median age was 64 months (range, 9–156) with a median weight of 19.48 kg (range, 8.4–46.5); the maximum tumor diameter at operation was 55.65 mm (range, 22–88); the operation time was 188.8 min (range, 120–210), the intraoperative blood loss was 20 ml (range, 5–50), and the length of postoperative hospital stay was 4 days (range 1–9). There was no significant difference in patients’ age, weight, location, tumor size, histological pattern and operation time between the two groups (P > 0.05). The RAS group had a significantly less intraoperative blood loss (P = 0.026) and less length of postoperative stay (P = 0.01) than the LAS group.ConclusionOur initial experience suggested that RAS in pediatric renal tumor was feasible and safe, and it reduced surgical trauma and accelerate postoperative recovery for the patients. Due to the limitations of sample size and study quality, the clinical importance of these findings still needs to be further verified.

Relapses of congenital mesoblastic nephroma: description of three clinical cases and literature review

Congenital mesoblastic nephroma (CMN) is a rare renal tumor of young children with intermediate biological behavior, accounting for 3.5-4% of all renal tumors in children. СMN is characterized by a favorable prognosis in case of radical surgical treatment. Relapses of CMN are considered to be quite a rare occurrence (4% of all cases), however, both local and metastatic relapses are possible. There are no fully standardized treatment approaches for patients with relapsed CMN. In our study, we performed a retrospective analysis of patients (n = 3) with a verified relapse of CMN who had received treatment at the D. Rogachev NMRCPHOI between 2012 to 2022 (132 months). At relapse, all the patients underwent at least one part of treatment at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation. The diagnosis of CMN was established at the Pathology Department of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation, based on a histological examination. The patients with the cellular histological subtype of CMN underwent fluorescent in situ hybridization testing for ETV6 gene rearrangements. The demographic characteristics, clinical data, the extent of initial treatment and relapse therapy were assessed. Here, we describe three clinical cases of relapse in patients with CMN. The median age at initial diagnosis was 0.8 months (range 0.7–1.4). Our analysis of the extent of primary surgical treatment, including nephrectomy, in all cases revealed the following factors associated with a higher risk of relapse: preoperative tumor rupture – 1, intraoperative tumor rupture – 1, inability to confirm tumor-free margins – 1. The distribution of histological subtypes was as following: classical CMN (n = 1), cellular CMN (n = 1), and mixed CMN (n = 1). One patient had local stage II and 2 patients had local stage III. The median time from diagnosis to disease relapse was 0.8 months (range 2.3–4.3). One patient with mixed CMN died 10.6 months after diagnosis from complications of intensive therapy carried out for extremely aggressive relapse. Two patients are alive after repeated surgical treatment (R1 resection) and adjuvant therapy with actinomycin D and vincristine (AV regimen) for 27 weeks in one case, and neoadjuvant therapy (AV regimen for 4 weeks), delayed surgery (R0 resection), and adjuvant therapy (AV regimen for 4 weeks) in the other case. These patients were followed up for 92.2 and 21.3 months, respectively. By acknowledging the possibility of recurrent CMN, it seems important to provide multidisciplinary clinical care to young children with renal tumors involving a detailed planning of surgical procedures, radical surgeries in accordance with practice guidelines and standards in surgical oncology, and careful follow-up, especially during the first year after surgery. The patients' parents gave consent to the use of their children's data, including photographs, for research purposes and in publications.

Outcomes of children with clear cell sarcoma of kidney following NWTS strategies in Shanghai China (2003-2021).

Although clear cell sarcoma of kidney (CCSK) is rare, it is the second most common renal tumor in children after Wilms' tumor. NWTS and SIOP are two major groups which had made tremendous efforts on renal tumors, but the strategies are different, for NWTS follows the upfront surgery principle providing definite pathology and the SIOP follows the upfront chemotherapy principle, each has its own advantages. Here we aimed to evaluate the outcomes of CCSK in China following NWTS strategies to analyze the prognostic factors. For this multicenter retrospective study, a total of 54 patients were enrolled from three children's hospitals, between April 2003 and December 2021. Treatment comprised upfront radical nephrectomy, followed by radiotherapy and intensive chemotherapy. Clinical records were regularly updated. Prognostic factors and survival rates were evaluated. The 54 enrolled patients had a median age of 37 months (range, 4 months to 11.4 years). The stage distribution was 16% stage I (n = 9), 30% stage II (n = 16), 39% stage III (n = 21), and 15% stage IV (n = 8). Among stage IV, metastasis sites included the lung (n = 6), bone (n = 1), and intra-orbital/cervical lymph node (n = 1). After a median follow-up of 5.6 years, the 5-year event-free survival (EFS) was 82.4±5.4%, and overall survival was 88.1±4.6%. The EFS was 100% for stage I, 93.8 ±6.1% for stage II, 71.1±10.0% for stage III, and 68.6±18.6% for stage IV. Univariate analysis revealed that staging (III/IV), tumor rupture, and inferior vena cava tumor thrombus were inferior prognostic factors. Multivariate analysis revealed that tumor rupture was independent poor prognostic factor (P = 0.01, HR 5.9). Among relapsed patients, relapse occurred a median of 11 months after diagnosis (range, 4-41 months), and 50% (4/8) achieved a second complete remission after multiple treatment. None of the six lung metastasis patients received lung RT, only one patient developed a relapse and was salvaged by RT after relapse. Tumor rupture was independent poor prognostic factor. Upfront surgery of NWTS strategies can make a definite pathology diagnosis, but how to reduce tumor rupture during surgery is important especially in developing countries. The outcomes of patients with stage I-III CCSK in China were comparable to findings in other developed countries. Better outcomes were achieved in stage IV CCSK by using an intensive chemotherapy regimen including carboplatin, which require further confirmation by AREN0321. Lung RT may be safely omitted in selected patients who achieve a compete radiographic response after 6 weeks of systemic treatment (including surgery). Treatment should be encouraged even in CCSK cases with metastasis and relapse.

Late effects of Wilms' tumor treatment.

Wilms' tumor (WT) is the most frequent renal tumor in childhood. Therapeutic management progression has increased survival rates, and as a result, long-term adverse effects. A descriptive retrospective study of a case series from 1977 to 2023 was carried out. The characteristics of the treatments received and the adverse effects listed on medical records were analyzed via phone surveys. 50 patients (25 boys-25 girls) with a mean age of 3.6 years (3 months-11years) at diagnosis were included. Most of them (94%) were treated according to the protocol established by the European standards of pediatric oncology, which are characterized by the use of neoadjuvant chemotherapy. In one patient, the American treatment scheme was followed. The most common drugs used were vincristine and actinomycin D (78%). Only 12 patients (28%) received anthracyclines. Unilateral nephrectomy was the most frequent surgical technique (84%). Renal disorders were the most common (46%). However, the occurrence of second neoplasias (9%) and reproductive disorders (8% between boys and girls) had a greater impact on patients' quality of life. Multiple - cardiac (23%), endocrine (26%), and pulmonary (15%) - disorders associated with the treatments received were reported. WT treatment has an impact on health. Adequate and rigorous surgery, close follow-up, and limiting chemotherapy doses and radiation exposure can minimize long-term sequels.

Rhabdoid Tumor: Imaging Findings of Rare Renal Tumor in Children

Rhabdoid Tumor: Imaging Findings of Rare Renal Tumor in Children

Immune checkpoint markers and tumour mutation burden in Wilms tumour: a study of 59 cases

Wilms tumour (WT) is the most common renal tumour in children, and studies of immune checkpoint inhibitors (ICIs) treatment and markers are limited in number. In this study we investigated the ICIs' related immune landscape by examining the expression of PD-L1, PD-1, CD8 and DNA mismatch repair (MMR) proteins by immunohistochemistry (IHC), tumour mutation burden (TMB), and correlations with histology and clinical outcome. Positive PD-L1 (SP263) expression was defined as modified combined positive score (CPS) ≥1. A total of 59 WTs (from 2000 to 2017), including eight (14.0%) with anaplasia, from 46 patients were analysed (45 primary and 14 metastatic). Thirteen WTs (13/59, 22%) were positive for PD-L1 (8 primary, 5 metastatic; CPS 1.11-3.42). Positive PD-L1 expression was associated with diffuse anaplasia (p<0.05) and significantly shorter progression-free survival (p<0.05) among WTs with favourable histology (n=39). CD8+ lymphocytes were present in all analysed WTs. A subset of CD8+ cells co-expressed PD-1, which was associated with favourable histology and treatment. MMR IHC stains identified two (2/18, 11%) WTs with isolated PMS2 loss. All six WTs analysed for TMB showed low mutation burden. We found CD8+ lymphocytes in all analysed WTs and identified a fraction of WT (17.8% of primary and 35.8% of metastatic) with positive PD-L1 CPS, suggesting potential response to ICIs in some patients.

A novel pyroptosis-related gene signature exhibits distinct immune cells infiltration landscape in Wilms’ tumor

BackgroundWilms’ tumor (WT) is the most common renal tumor in childhood. Pyroptosis, a type of inflammation-characterized and immune-related programmed cell death, has been extensively studied in multiple tumors. In the current study, we aim to construct a pyroptosis-related gene signature for predicting the prognosis of Wilms’ tumor.MethodsWe acquired RNA-seq data from TARGET kidney tumor projects for constructing a gene signature, and snRNA-seq data from GEO database for validating signature-constructing genes. Pyroptosis-related genes (PRGs) were collected from three online databases. We constructed the gene signature by Lasso Cox regression and then established a nomogram. Underlying mechanisms by which gene signature is related to overall survival states of patients were explored by immune cell infiltration analysis, differential expression analysis, and functional enrichment analysis.ResultsA pyroptosis-related gene signature was constructed with 14 PRGs, which has a moderate to high predicting capacity with 1-, 3-, and 5-year area under the curve (AUC) values of 0.78, 0.80, and 0.83, respectively. A prognosis-predicting nomogram was established by gender, stage, and risk score. Tumor-infiltrating immune cells were quantified by seven algorithms, and the expression of CD8( +) T cells, B cells, Th2 cells, dendritic cells, and type 2 macrophages are positively or negatively correlated with risk score. Two single nuclear RNA-seq samples of different histology were harnessed for validation. The distribution of signature genes was identified in various cell types.ConclusionsWe have established a pyroptosis-related 14-gene signature in WT. Moreover, the inherent roles of immune cells (CD8( +) T cells, B cells, Th2 cells, dendritic cells, and type 2 macrophages), functions of differentially expressed genes (tissue/organ development and intercellular communication), and status of signaling pathways (proteoglycans in cancer, signaling pathways regulating pluripotent of stem cells, and Wnt signaling pathway) have been elucidated, which might be employed as therapeutic targets in the future.

Effect of Preoperative Chemotherapy in Reduction of Tumor Volume in Wilms Tumor in Relation to Histology

Background: Wilms tumor (WT) is the most common renal tumor in children under5 years. The survival rates of children with Wilms tumor have improved dramatically over a few decades. Objective: To find out the effect of preoperative chemotherapy in the reduction of tumor volume in Wilms tumor and its correlation with tumor histology. Methodology: A total of 53 patients diagnosed with WT under 15 years were enrolled. After a complete history and physical examination, all information including demographics, metastatic status, pre and post-chemotherapy volume, histology, postop stage and surgical complication was collected and entered on Performa. All patients received neo-adjuvant chemotherapy according to the SIOP protocol. Data was entered and analyzed in SPSS 23. Results: Fifty-three patients were included. There were 33 (62.3%) male and the mean age was 4.45 +2.2 years. Thirty-two (60.4%) children had localized disease and13 (24.5%) children had lung metastasis. There was a significant reduction of tumor volume of &gt;500ml in 8(15.1%) patients after preoperative chemotherapy and the majority 18(34 %) patients had 100-200 ml decrease in tumor volume. Intermediate risk histology 40 (75%) was most prevalent. During surgery, 35 (66%) children had no complications .Thirty-nine (73.5%) patients were cured, 4 (7.5%) patients were expired and 5 (9.4%) got left against medical advice (LAMA). Conclusion: Our study infers that pre-operative chemotherapy reduces the tumor volume remarkably in WT making resection feasible

Renal primitive neuroectodermal tumor in an adolescent: a case report and review of literature

Renal primitive neuroectodermal tumor is a highly malignant neoplasm that commonly affects young adults and infrequently presented in children and adolescents. We report a case of a 14-year-old female child who presented with abdominal mass. PET-CT showed an FDG avid cystic lesion in the inter and lower polar regions of the right kidney, extending into the right renal fat and renal vein, with multiple FDG avid lesions in the axial and appendicular skeleton, suggesting renal mass with bony metastases. Biopsy confirmed the diagnosis of primitive neuroectodermal tumor of the kidney. The patient completed six cycles of chemotherapy with partial response and subsequently the patient defaulted and lost to follow-up. To emphasize the critical significance of renal PNET in the differential diagnosis of renal tumors in children.

The application of machine learning based on computed tomography images in the identification of renal tumors in children.

The clinical manifestations of Wilms tumor and non-Wilms tumor in children are similar, and the only way to confirm the diagnosis is by postoperative pathology. Computed tomography (CT) is one of the main methods for preoperative diagnosis of the two, but it is also difficult to distinguish because it is easily affected by the subjective influence and the experience of the radiologists. The CT images of 82 children with renal tumors admitted to the Department of Pediatric Urology, Shandong Provincial Hospital from January 2011 to March 2022 were retrospectively analyzed. First, we drew the two-dimensional (2D) region of interest (ROI) of the largest cross-section on the corticomedullary phase (CMP) and nephrogenic phase (NP) images, and extracted seven types of 107 features in the ROI. Then, the texture features with similarity greater than 95% and repetition less than 90% were screened out, and the remaining texture features were further screened by analysis of variance (ANOVA) and recursive feature elimination (RFE). Finally, 15 texture feature were used to build the machine learning (ML) models. We used the synthetic minority oversampling technique (SMOTE) and 10-fold cross-validation to build ML models and verified them in the training, testing, and internal validation sets. The area under the receiver-operating characteristic curve (AUC) and calibration curve were used to evaluate the diagnostic performance. We collected 77 CMP and 81 NP images, which were randomly divided into the training set and the testing set according to the ratio of 7:3. In the internal validation of CMP, the Mean-PCC-ANOVA-5-AE pipeline model achieved the highest AUC 0.792 [95% confidence interval (CI): 0.653-0.930], and its accuracy (ACC), sensitivity (SEN), and specificity (SPE) were 0.833, 0.539 and 0.927, respectively. Correspondingly, in NP, the Mean-PCC-ANOVA-2-LR pipeline model achieved the highest AUC 0.655 (95% CI: 0.485-0.82) in the internal validation. The ACC, SEN, and SPE were 0.696, 0.539, and 0.744, respectively. The ML models based on CT images have good diagnostic efficiency in differentiating Wilms tumors from non-Wilms tumors in children.

Correlation of CT Scan Response to Necrosis and Volume Changes With Histopathology in Children With Wilms' Tumor

BackgroundWilms’ tumor is the most common renal tumor in children. ObjectiveTo correlate the percentage of necrosis and tumor volume change found in preoperative Contrast Enhance Computed Tomography (CECT) scan of the abdomen with post-operative histopathological findings of Wilms Tumor (WT). MethodsIn this prospective study from January 2020 to December 2022, out of 33 patients, 15 patients with unilateral localized WT (stage I, II, and III) treated according to SIOP UMBRELLA protocol 2016 were included. Bilateral, syndromic, and stage IV WT were excluded. The radiological response was measured in preoperative CECT by estimating the percentage of necrosis found in static images and compared with post-operative histopathological findings. Tumor volume changes were measured by comparing CECT at diagnosis and following chemotherapy. Tumor volume change was also compared with histology. ResultsThere was a significant positive correlation between radiological response to necrosis with histology as per Pearson correlation. Significant positive correlation also found between volume changes on pre and post chemotherapy CECT with histology as per Spearman correlation. ConclusionsThe changes in tumors during preoperative radiological evaluation and histologically confirmed necrosis are strongly related.

Congenital Mesoblastic Nephroma Mimic Wilms Tumor on 18 F-FDG PET/CT and PET/MR.

Congenital mesoblastic nephroma is an extremely rare, low-grade malignant renal tumor in children. A 10-month-old boy and a 4-month-old girl were admitted to our hospital with a huge abdominal mass. For staging of the mass, 18 F-FDG PET/CT and PET/MR were performed showing a huge heterogeneous abdominal mass accompanied by extensive heterogeneous aggregation. Both of them were highly suspected to be Wilms tumor, the most common renal malignant tumor in children. However, histopathological examination after surgery confirmed congenital mesodermal nephroma.

Clear Cell Sarcoma of the Kidney Mimicking Wilms Tumor in a Child

Abstract Background: Clear cell sarcoma of the kidney (CCSK) is a rare malignant renal tumor in children, the diagnosis of which is a challenge due to nonspecific clinical and radiological presentation. Clinical Description: A 4-year-old boy presented with a 2-day history of abdominal pain and hematuria, without oliguria, pallor, or hypertension. His renal function was within the normal limits. An initial ultrasound of the abdomen showed an iso- to hyperechoic lesion in the mid pole of the right kidney causing compression of the pelvicalyceal system. A computed tomography scan revealed a relatively heterogenous hypoenhancing mass lesion with a “claw sign” suggestive of solid renal neoplasm with doubtful infiltration of quadratus lumborum and psoas muscle, most probably Wilms tumor. Management and Outcome: The child was started on neoadjuvant chemotherapy with vincristine, actinomycin D, and doxorubicin according to the National Wilms Tumor Study protocol (NWTS) suspecting stage III Wilms tumor. After six cycles, surgical resection of the tumor was done, which on histopathological examination, was consistent with CSSK. The child received postoperative flank irradiation. Chemotherapy was escalated to Regimen I (vincristine, doxorubicin, cyclophosphamide, and etoposide) for 24 weeks. The child improved and was free of metastasis till the last follow-up. Conclusion: Before a renal tumor is labeled as Wilms tumor, all efforts must be made to rule out the more sinister, but similar appearing CCSK, so that an effective and aggressive treatment regimen can be administered timely.

A massive primary congenital mesoblastic nephroma was successfully managed through open total nephrectomy: a case report

Background: Congenital mesoblastic nephroma is the most common renal tumor in children under the age of 6 months, comprising 3–10% of all kidney tumors in children. It is a rare and mostly benign tumor. It divides into cellular, classic, and mixed subtypes. It is typically detected in the third trimester of pregnancy using ultrasonography and magnetic resonance imaging. The best treatment is surgically by completely removing the tumor. Case presentation: We reported a case of a one-day-old female who was born at 31 weeks gestation weighing 1670 g. Preterm labor was due to polyhydramnios, which was diagnosed predelivery. A large mass was detected in the left hypochondrium using computerized tomography, total nephrectomy was performed, and the histopathological examination of the specimen confirmed the diagnosis of congenital mesoblastic nephroma. Clinical discussion and conclusion: Early polyhydramnios could be the most significant sign of renal tumors in infants, especially congenital mesoblastic nephroma.

An Observational Case-Control Study on Parental Age and Childhood Renal Tumors.

Despite excellent outcomes, many open questions remain about Wilms tumor (WT). Influences and risk factors for tumorigenesis, as well as tumor aggressiveness and recurrence, are not fully understood. Parental age plays a role in various childhood diseases and is also discussed as a risk factor for childhood cancer. We analyzed both maternal and paternal age at birth as risk factors for the occurrence of Wilms and non-Wilms tumors in children and investigated whether older maternal or paternal age is associated with a higher tumor incidence. During 1990 and 2019 we collected data from 3991 patients from the multicenter studies SIOP9/GPO, SIOP 93-01/GPOH, and SIOP 2001/GPOH, of whom maternal and paternal age was available in 2277 cases. Data from the Federal Statistical Office containing live births in Germany from 1990-2019 served as a comparative database. For maternal age at birth, the control data yielded 22,451,412 cases and for paternal age yielded 19,046,314 cases. Comparing maternal and paternal ages of the study patients with those of the control data, we confirmed that higher parental age is not correlated with the incidence of renal tumors in childhood. Mean ages of fathers and mothers in patients and the control cohort increased between 1991 and 2019 (fathers: 30.28 vs. 34.04; mothers: 27.68 vs. 29.79 in the patient group and 31.29 vs. 34.23 and 28.88 vs. 32.67 in the control group, respectively) without higher numbers of patients with kidney cancer over time. No influence was found for the subtype of cancer nor for syndromes. In addition, overall survival of patients is independent of the year of diagnosis and the age of the parents but depends on histology type and stage in WT.

Böbreğin Berrak Hücreli Sarkomu: Oldukça Nadir Bir Olgu Sunumu

Clear cell sarcoma of the kidney (CCSK) is one of the most common malignant renal neoplasms in childhood, although it is quite rare. Its incidence peaks around the age of 3 and it is twice as common in males. We present a rare case of CCSK showing a rare histopathological pattern in terms of age and gender. A 7-month-old female patient presented with complaints of vomiting, abdominal swelling, and diarrhea. Imaging analysis revealed a mass in the right kidney, and right radical nephrectomy was performed, considering Wilms tumor (WT). There was a solid gray-white mass that completely filled the kidney, with a maximum dimension of 8.5 cm, macroscopically. The samples obtained showed intratubular structures within the tumor and kidney parenchyma in limited areas at the periphery. The tumor had a normochromic monotonous nucleus with occasional clear cytoplasm and mostly exhibited a palisade-like arrangement pattern. In the differential diagnosis, with blastemal WT and Ewing sarcoma being the primary considerations, the positivity of CyclinD1 markers, negativity of other markers, and morphological characteristics were evaluated in favor of CCSK with a palisaded Schwannian pattern. The patient was put on an intensive chemotherapy process, but was lost after relaps at weet 24. CCSK is seen in a similar age group as WT but is distinguished by its rarity and relatively worse prognosis. Histopathologically, it most commonly presents in a myxoid pattern and least commonly in anaplastic pattern. The palisaded schwannian type seen in our case is recorded at a rate of 11%. No spesific diagnostic marker has been identified immunohistochemically, but the overexpression of markers such as CyclinD1, BCOR, and EZH2 is reported to be helpful in diagnosis. Due to its high metastatic potential and limited treatment options, further research is needed to understand the molecular nature of the disease.

A radiomics nomogram for preoperative prediction of nephron-sparing surgery in patients with bilateral Wilms tumor.

Bilateral Wilms tumor (BWT) is a relatively rare malignant renal tumor in children. Nephron-sparing surgery (NSS) is the preferred surgical approach for treating BWT, but lacks uniform surgical indications worldwide. This study aimed to summarize the clinical and imaging features of BWT children, establish a radiomics nomogram, and predict the feasibility of NSS for improving outcomes. A 12-year retrospective single-center review was conducted on clinical data and preoperative imaging features of BWT patients. The tumor kidneys were divided into NSS and non-NSS groups. Logistic regression analysis was performed to identify independent predictors and develop a prediction model of the feasibility of NSS in BWT patients. A radiomics nomogram was constructed and internally validated by the parametric bootstrapping method. A total of 58 BWT patients (115 renal units) were included in this study. After evaluations based on preoperative imaging and clinical data, 94 renal units underwent NSS with negative resection margins and were included in the NSS group, whereas 16 renal units with positive resection margins, macroscopic residual, or total nephrectomies were included in the non-NSS group. Tumor size [odds ratio (OR): 0.540, 95% confidence interval (CI): 0.308-0.945], relationship with the collecting system (OR: 0.013, 95% CI: 0.0004-0.370), and remaining renal parenchyma (RRP) proportion (OR: 71.23, 95% CI: 1.632-3108.8) were identified as independent predictors for NSS. A nomogram was constructed based on these factors, which demonstrated great consistency between the predicted and observed feasibility of NSS. The model presented with good discriminative ability [area under the curve (AUC), 0.982]. The decision curve analysis (DCA) revealed the clinical usefulness of the model. This study analyzed the clinical and preoperative imaging data of BWT patients and identified three independent predictors for the feasibility of NSS, including tumor size, relationship with the collecting system, and residual renal parenchyma proportion. The radiomics nomogram established in this study can provide individualized predictions to assist clinicians in making better decisions and improving patient outcomes.

Prevalence of Nephroblastoma in Children from 0 to 15 Years at Sikasso Hospital

Introduction: Nephroblastoma or Wilms tumor is the most common renal tumor in children (90%) and accounts for 5- 10% of pediatric cancers. The WHO estimates the annual number of new cases of childhood cancer at 160,828. In Mali, nephroblastoma is the 3rd most common malignant disease in children after lymphoma and retinoblastoma. The main objective of this work is to study the frequency of renal tumors in children aged 0 to 5 years in the hospital of Sikasso. Method: This will be a retrospective, descriptive and analytical study of all cases of nephroblastoma diagnosed over a 5-year period from 2017 to 2021 at Sikasso Hospital. Result: The most represented age range was 3 -7 years. Male gender was the majority in 62.50% of cases, with a sex ratio of 1.7. All patients had an abdominal mass, a lumbar contact. Patients with a duration of symptom evolution between 1 and 2 months were in the majority in 50% of cases. The tumor was unilateral in 87.50% of cases. Lung abnormalities were present in only 12.50% of cases. Hematuria was found in 37.50% of cases. Left kidney tumor was the majority in 75.00% of cases. Conclusion: Nephroblastoma remains the most frequent renal tumor in children, however, the delay in diagnosis remains a major challenge.

Tailored treatment of childhood renal tumors using artificial intelligence to predict tumor response to preoperative chemotherapy

Tailored treatment of childhood renal tumors using artificial intelligence to predict tumor response to preoperative chemotherapy

Prediction of Wilms' Tumor Susceptibility to Preoperative Chemotherapy Using a Novel Computer-Aided Prediction System.

Wilms' tumor, the most prevalent renal tumor in children, is known for its aggressive prognosis and recurrence. Treatment of Wilms' tumor is multimodal, including surgery, chemotherapy, and occasionally, radiation therapy. Preoperative chemotherapy is used routinely in European studies and in select indications in North American trials. The objective of this study was to build a novel computer-aided prediction system for preoperative chemotherapy response in Wilms' tumors. A total of 63 patients (age range: 6 months-14 years) were included in this study, after receiving their guardians' informed consent. We incorporated contrast-enhanced computed tomography imaging to extract the texture, shape, and functionality-based features from Wilms' tumors before chemotherapy. The proposed system consists of six steps: (i) delineate the tumors' images across the three contrast phases; (ii) characterize the texture of the tumors using first- and second-order textural features; (iii) extract the shape features by applying a parametric spherical harmonics model, sphericity, and elongation; (iv) capture the intensity changes across the contrast phases to describe the tumors' functionality; (v) apply features fusion based on the extracted features; and (vi) determine the final prediction as responsive or non-responsive via a tuned support vector machine classifier. The system achieved an overall accuracy of 95.24%, with 95.65% sensitivity and 94.12% specificity. Using the support vector machine along with the integrated features led to superior results compared with other classification models. This study integrates novel imaging markers with a machine learning classification model to make early predictions about how a Wilms' tumor will respond to preoperative chemotherapy. This can lead to personalized management plans for Wilms' tumors.